缺血性中风大小动脉病变与预后的关系

Relationship between large and small artery disease of ischemic stroke and stroke prognosis

目的探讨缺血性中风大小动脉病变与预后的关系。方法将207例缺血性中风急性期患者，根据缺血性脑血管病类肝素药物治疗急性缺血性脑卒中试验（TOAST）分型诊断标准结合影像学的方法，分为大动脉病变组87例、小动脉组病变120例，对2组患者中风病的美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（MRS）、日常生活活动能力量表（ADL）评分进行动态比较。结果①中风病发病后1、2、3、7、14、28d6个时点NIHSS量表得分的动态演变显示出与证候得分类似的规律性，大动脉病变的曲线形态多为发病后先上升，后下降；而小动脉病变曲线形态表现为先下降后上升，再下降，在第2天多会出现一个波谷，曲线波峰多在3～7d之间。②在大小动脉病变的预后方面，大动脉病变组MRS评分、NIHSS评分明显高于小动脉病变组，提示大动脉病变组较小动脉病变组预后差。2组ADL差异不显著。结论缺血性中风大小动脉病变表现出不同的预后变化规律，大动脉病变组较小动脉病变组预后差。

Objective To discuss the relationship between large and small artery disease of ischemic stroke and stroke prognosis. Methods The patients with acute ischemic stroke （n = 207） were divided into large artery disease group （n = 87 ） and small artery disease group （n = 120） according to the differentiation diagnostic criterion of Trial of Org 10172 in Acute Stroke Treatment （TOAST） combining with imageology. The scores of NIH stroke scale （ NIHSS）, modified Rankin scale （MRS） and activities of daily living （ADL） scale were compared dynamicly between two groups. Results （~）The regularity of NIHSS scores was similar to that of syndrome scores at 6 time points （1 day and 2, 3, 7, 14 and 28 days） after stroke. The curve of large artery disease ascended firstly and then descended, while the curve of small artery disease descended firstly, then ascended and descended again. A trough of wave appeared on the second day, and peaks of wave showed on the third to seventh days. （~）For the prognosis of large and small artery disease, the MRS scores and NIHSS scores were significantly higher in large artery disease group than those in small artery disease group, which indicated that the prognosis was poorer in large artery disease group than that in small artery disease group. There was no significant difference in ADL between two groups. Conclusion There is difference in prognosis regulation between large and small artery disease of ischemic stroke. The prognosis is poorer in large artery disease group than that in small artery disease group.